Provider Demographics
NPI:1225267131
Name:LYDON, LISA A (LPC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:A
Last Name:LYDON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1230 W. WASHINGTON ST.
Mailing Address - Street 2:SUITE 401
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85281
Mailing Address - Country:US
Mailing Address - Phone:602-794-1752
Mailing Address - Fax:602-794-1895
Practice Address - Street 1:1500 N. PRIEST DR.
Practice Address - Street 2:SUITE 114
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85821
Practice Address - Country:US
Practice Address - Phone:602-794-1752
Practice Address - Fax:602-794-1895
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-13
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ13056101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional